Superbug Fungus, Candida Auris Spreads in the US

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According to the CDC, clusters of pan-resistant Candida auris have appeared among hospitalized patients in Washington DC and Texas.

Candida auris, a superbug fungus, was first discovered in Tokyo, in 2009. Notably, around the same time outbreaks of the fungal infection also occurred in countries such as India, Pakistan, and South Africa. The fungus typically infects immunocompromised individuals, especially hospitalized patients. More recently, it appeared in hospitalized COVID-19 patients in Brazil.

This particular species of fungus is often referred to as a global health concern due to its resistance against multiple anti-fungal drugs. Three major classes of antifungal drugs are commonly used to treat candidiasis in humans: azoles, polyenes, and echinocandins. However, some strains of the fungus are resistant to all three classes of antifungals; thus, called pan-resistant C. auris.

Now, the Centers for Disease Control and Prevention (CDC) has reported two independent clusters of the pan-resistant C. auris in the country. The report describes a total of 123 cases, isolated between January to April 2021. Although pan-resistant strains of the fungus have occurred in the past, this is the first time transmission is being seen within patients in hospitals.

We’re seeing this in two unrelated situations where this high level of resistance seems to be spreading. That’s obviously very concerning, because now it means that any high-risk individual could acquire it and then develop a severe infection that has very limited treatment options.

Dr. Meghan Lyman, lead author of the report

30% Died Within 30 Days

According to the CDC, approximately 85% of C. auris isolated in the US are resistant to azoles, 33% to the polyene Amphotericin B, and 1% to echinocandins. Therefore, doctors usually rely on echinocandins for treating invasive infections.

According to the report, a total of 101 cases of C. auris occurred at a long-term facility in Washington DC between January and April 2021. The cluster included three cases of pan-resistant C. auris. Furthermore, 22 cases occurred at two acute care hospitals in Texas. Out of them, two patients had the pan-resistant strain and five were resistant to both echinocandins and fluconazole. There is currently no evidence of a link between the two clusters.

Within 30 days, 30% of the 123 patients died; however, it is unclear whether C. auris is to blame for them all. Surprisingly, none of the patients with pan-resistant or echinocandin-resistant strains had received any anti-fungal treatment in the past. Health officials believe the clusters likely occurred due to transmission in the health care setting.

Obviously the infections are more severe, and a few of them were bloodstream infections, but even in the colonization cases, we’re still concerned about those because they can spread to other people who could develop infections

Dr. Meghan Lyman, lead author of the report

Reference:

Lyman M, Forsberg K, Reuben J, et al. Notes from the Field: Transmission of Pan-Resistant and Echinocandin-Resistant Candida auris in Health Care Facilities ― Texas and the District of Columbia, January–April 2021. MMWR Morb Mortal Wkly Rep 2021;70:1022–1023. DOI: http://dx.doi.org/10.15585/mmwr.mm7029a2

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